Dealing with hypoglycemia

What is a hypoglycemic attack?

A hypoglycemic attack is when your blood glucose level falls below 75 mg/dl. This happens when you have more insulin working in your body than you need. Your symptoms should warn you that your blood glucose level is low, although if your body is accustomed to blood glucose levels below 75 mg/dl, your symptoms may be reduced or absent.

What would I feel like if I had a hypoglycemic attack?

When your blood glucose level is between 50 and 75 mg/dl, you may get symptoms such as palpitations, sweating, trembling, feeling anxious, turning pale, and hunger. If your blood glucose level falls below 50 mg/dl your symptoms alter as your brain starts to be deprived of glucose and no longer functions well. You might feel disorientated, find it difficult to concentrate, or have blurred vision or a headache. You may also be uncooperative or aggressive.

How likely am I to have a hypoglycemic attack?

You are at risk of hypoglycemic attacks only if you take insulin or insulin-stimulating pills, such as sulfonylureas. (Even if you manage your diabetes with other types of pills or with diet and exercise, you may have hypoglycemic attacks if the blood glucose rises and insulin secretion is delayed. The delayed insulin production caused by your diabetes can cause your blood glucose to drop after a meal, but this will correct itself without you needing extra carbohydrate.) Hypoglycemic attacks are more likely if you lose weight – you will probably need less medication.

How can I prevent myself from having a hypoglycemic attack?

Identifying situations where you are at risk of hypoglycemic attacks, for example, eating less, drinking alcohol, or being in a hot climate/environment, such as a hot bath or sauna, will help you plan ahead. In these situations, carrying extra snacks or reducing your insulin/pill dose in advance allows you to be prepared if your blood glucose drops. If it helps, ask friends, family, or colleagues to remind you to test your blood glucose or to eat snacks. If you suspect that your blood glucose level is falling at any time, a blood test will give you the information you need to take action.

My blood glucose sometimes drops below 75 mg/dl but I feel fine. Do I need to do anything?

Yes, any blood glucose level below 75 mg/dl is defined as a hypoglycemic attack, regardless of how you are feeling. If you don’t get symptoms – or you used to, but don’t any more – keeping your blood glucose out of the hypoglycemia range for a few weeks can help restore your symptoms. If you have hypoglycemia symptoms and a test result of 75 mg/dl, don’t wait for your blood glucose to drop below that level – treat yourself for hypoglycemia immediately.

How should I treat a hypoglycemic attack?

The initial treatment for hypoglycemia is to eat for drink something that is high in glucose and quickly absorbed. The options include: three glucose pills (available from pharmacies); a high-energy sugar drink, ordinary cola, or lemonade; two teaspoons of sugar dissolved in water; or one dose or 10g of glucose or dextrose gel (available from pharmacies). Follow this by eating a slower-acting carbohydrate food to help keep your blood glucose level up. Options include a sandwich, a piece of toast, a piece of fruit, two or three cookies, or a bowl of cereal.

Will I become unconscious or pass out if I have a hypoglycemic attack?

If you don’t treat or receive treatment for your hypoglycemic attack and your blood glucose level continues to fall, you may lose consciousness, although this is rare. It usually takes up to 2 hours or more after your early warning symptoms start – but it may happen within 10-15 minutes of the later symptoms. If you lose consciousness and you don’t receive help, your body will usually gradually recover by itself, and you regain consciousness naturally within an hour or two.

One of my friends has a glucagon injection kit at home. Should I have one?

Glucagon is sometimes used to treat serious hypoglycemic attacks – it works by converting glycogen in your liver to glucose. If you have good early warning symptoms, you do not need a glucagon kit because you will have plenty of time to take glucose followed by a carbohydrate snack. If you don’t get the early symptoms, or you tend to become disoriented or lose consciousness very quickly, it might be a good idea to get a glucagon kit so that a colleague, friend, or family member can inject you with glucagon if necessary. If you are unsure about whether you need a glucagon kit, consult your doctor to help you decide.

What will happen to me if I have a hypoglycemic attack in the middle of the night when I am asleep?
You may wake up, but even if you remain asleep, your body will eventually correct your blood glucose level by converting glycogen in your liver into glucose and releasing it into your bloodstream. Excess insulin also wears off naturally in time. Hypoglycemic attacks can, rarely, be life-threatening if you have been drinking large amounts of alcohol on an empty stomach because alcohol impairs this corrective mechanism. This is why it is essential to balance your alcohol intake with food or to take a lower dose of insulin or insulin-stimulating tablets if you know that you are going to be drinking.

Sometimes after a hypoglycemic attack my blood glucose goes really high. Does this mean I’ve eaten too much?

Not necessarily. Your liver responds to a hypoglycemic attack by releasing extra glucose into your bloodstream, which can make your blood glucose rise too high after you have had a hypoglycemic attack. Eating about 1 oz of a carbohydrate food should be sufficient to treat your hypoglycemic attack – eating a greater amount than this can contribute to your high blood glucose reading.

Understanding your blood pressure for diabetes

Myth “You know if you have high blood pressure because it gives you headaches”

Truth High blood pressure does not always give you symptoms, and it is often found by chance during routine health checkups. Having your blood pressure checked at your annual diabetes reviews, and more frequently if your health professional suggest it, will be a more reliable indicator of whether your blood pressure is high.

My doctor tested me for Type 2 diabetes because I am having treatment for high blood pressure. Why is that?

Type 2 diabetes and high blood pressure are both linked to insulin resistance, so if you have one of these conditions it is common to have the other, too. If you keep both your blood pressure and your blood glucose level under control, your chances of developing long-term complications, especially heart disease, are greatly reduced.

What is high blood pressure?

If your larger blood vessels become more rigid and your smaller blood vessels start to constrict, your blood has to flow through a narrower space than before. The result is greater pressure on your blood vessel walls, which is known as high blood pressure or, medically, as hypertension. Having high blood pressure is common when you have Type 2 diabetes.

I have high blood pressure but I don’t feel sick. Why does it need to be treated?

Having high blood pressure makes you much more prone to cardiovascular disease (CVD) – a serious condition that develops over many years as your blood vessels gradually become narrower and less flexible. You may have high blood pressure without knowing it and, if it remains untreated, you may develop angina (severe chest pain) or have a heart attack or a stroke. Taking your blood pressure treatment as prescribed and having regular checkups can help prevent these serious conditions.

What should my blood pressure be?

If you have Type 2 diabetes your blood pressure should be below 130/80 millimeters of mercury (mmHg). In some situations, for example if you have already developed kidney damage (nephropathy), you may need to keep your blood pressure lower, for example, 125/75 millimeters of mercury (mmHg) to prevent further damage. Discussing your ideal blood pressure level, and ways to achieve it, with your health professional will give you the level that is right for you.

Why are there two figures in my blood pressure measurement?

The top figure refers to the level of pressure in your blood vessels as your heart contracts and pumps blood around your body. This is known as the systolic blood pressure. The second figure is the lowest pressure as your heart relaxes between beats. This is known as the diastolic blood pressure.

What can I do to lower my blood pressure?

Stop smoking and lose weight if you need to, eating more fresh fruit and vegetables and less saturated fat and salt (for example, less processed or commercially prepared meals) to help reduce your blood pressure. Physical activity will also lower your blood pressure. Take any blood pressure pills that you have been prescribed, even if they do not affect the way you feel, to help keep your blood pressure in the recommended range.

How low can my blood pressure go?

It would be unusual for your blood pressure to be under 100/60 mmHg if you are otherwise healthy. For every 10 mmHg drop in your systolic blood pressure (the first figure) toward this level, you benefit by reducing your risk of heart attack or stroke.

The A1c Test

What is an A1c test?

The A1c test (each letter is pronounced separately) provides information about your blood glucose level. It measures the amount of glucose attached to the hemoglobin (oxygen-carrying molecule) in your blood and gives an average picture of your blood glucose level over the previous 6-8 weeks. The test involves having a blood sample taken from your arm or finger. The sample is then analyzed in a laboratory or in the clinic. The A1c test is not affected y what you have eaten or drunk in the last few days.

How often do I need an A1c test?

Your A1c test is taken every three months. You might need more frequent tests if , for example, your medication has changed or to assess the effect of any lifestyle changes you have made. Unless you are pregnant, you are unlikely to have an A1c test more frequently than every 2 months because it takes this amount of time for the results to change significantly.

What do my A1c test results mean?

A1c results are given as a percentage – the closer they are to 7 percent (or below), the nearer you are to everyday blood glucose results between 75 and 130 mg/dl. If your A1c result is above 7 percent, discussing your diabetes management with your health professional can help you decide what needs to change. Every 1 percent rise in your A1c result increases the risk of long-term complications by 30 percent, so taking steps to keep your A1c level at or below 7 percent provides great long-term benefit.

If I have a result of 7 percent or lower, will this prevent the long-term complications of diabetes?

Your A1c is only one factor that influences your risk, but it is an important one. It is impossible to guarantee that you will never develop the long-term complications of diabetes, such as eye and kidney problems, but the more time your A1c is below 7 percent the higher your chance of staying healthy, and the risk of your developing these problems is greatly reduced.

I’m hoping to get pregnant. Do I need an A1c test beforehand?

Yes, your health professional will check your A1c if you are planning a baby. High readings can affect your baby’s development, so working to achieve a reading below 7 percent before you conceive is very important.

My home blood glucose tests are usually in the range 75-130 mg/dl. Will my A1c level be around 7 percent?

Your A1c test is a measure of your blood glucose levels at all times of the day, so if you don’t do home tests very often, you may be falsely reassured by results that are in the 75-130 mg/dl range. However, if you test at least once or twice a day and all your results are in the recommended range, your A1c level will be close to or below 7 percent.

Can I buy a home A1c testing kit?

You can buy a home A1c testing kit at some pharmacies. It might be useful to discuss your health professional whether home A1c testing would benefit you before you buy a kit.

My tests are all under 180 mg/dl, but my A1c is 12 percent. Why is this?

Although your results are below 180 mg/dl at the times you do them, they may be higher at other times. This will affect your A1c result. Varying the times you test, for example, after meals as well as before, and aiming for results between 75 and 130 mg/dl, helps influence your A1c result.

Carrying out a blood glucose test

Do all blood glucose meters work in the same way?

No. the exact procedure for carrying out a blood test will vary according to which type of blood glucose meter you have. With most machines, you will need to prepare the meter for use, insert a blood testing strip, obtain a blood sample, apply blood to the testing strip, and wait for a result. Check the instructions that come with your meter to determine any variations to this routine.

How can I make sure I get the most accurate result possible?

Your blood glucose meter comes with instructions on how to sue it, so the first step is to read and follow these. The following additional tips are also important to ensure an accurate reading: wash and dry the site you intend to take blood from; calibrate your meter each time you start a new container of testing strips; use a new testing strip for each test. Also, avid “topping up” blood on your strip if your equipment isn’t designed for this.

Why does my blood glucose meter turn itself off before I’ve done a test?

If you insert your testing strip into the meter and then take too long to apply your blood, your meter switches itself off to save battery power. If this happens, you need to remove the testing strip and reinsert it. Once you have put a drop of blood on the testing strip and the strip is in the meter, a built-in timing device takes over.

Is there a device that can continuously monitor my blood glucose level?

There are two types of device available for continuous testing: a watchlike device that you wear on your wrist and a machine that is connected to a needle in your abdomen. These are not widely used, partly because they are more expensive than a blood glucose meter and partly because the technology is still being developed. If you use this equipment, you still need to do some fingerprick tests to calibrate the machines, and you need to buy ongoing supplies for the equipment.
Why do I need to keep a diary of my test results?

Recording the results of your blood glucose tests will enable you to see how your blood glucose level changes over the course of a day or a week. If you notice patterns of high and low blood glucose readings, you can take action to bring your blood glucose level back within the recommended range.

What information do I need to put in my monitoring diary?

A monitoring diary provides space for you to enter the results of seven or more blood glucose tests a day, together with the date and time of the tests. You can also record what type and dose of medication you are taking plus any additional relevant information, such as what has caused high or low readings or what changes you are making to correct fluctuating readings.

Can I create an electronic diary?

Yes, some blood glucose meters have a facility that allows you to download your results and analyze them on a computer. This facility enables you to view your results in graph or table form, and you can also look specifically at readings at certain times of day, or average readings within various time scales, for example over the last 7 days.

Monitoring your diabetes – What your results mean?

What can I do if I regularly get high readings?

You can identify the cause by looking at the times when your readings are high and considering what you were doing in the hours leading up to this. Once you’ve done this assessment, the next step is taking some action to remedy the situation. You might decide, for example, to decrease the amount of food you eat or increase the amount of physical activity you do.

I hurt my back while gardening and have needed to rest. My test results have all been over 270 mg/dl since. What should I do?

Your blood glucose level is likely to be high because you are inactive, so temporarily increasing the dose of your pills or insulin (if you are using medication) will bring it down again. When you are better and become active again, your blood glucose level is likely to fall, so you may need to decrease the dose of your medication at this point. You can also increase your pills or insulin dose like this when you are ill or when you gain weight – when you recover or lose weight you can adjust your dose down again.

My blood glucose keeps swinging between high and low readings – what should I do?

This may happen when you treat a hypoglycemic attack with glucose or a sugary snack. Since your liver also releases glucose to compensate, you end up with a high level of glucose in your blood. Reducing your medication, or altering your activity levels or eating patterns, can help you avoid hypoglycemic attacks. Other causes of swinging blood glucose level are an irregular daily routine or food intake, or variations in the timing or dose of your medication. Examining these possibilities will help you identify the cause.

How often does my blood glucose need to be high before I should worry about it?

A single or an occasional high reading with an obvious cause will not cause long-term damage to your nerves or blood vessels, but if you have high readings for more than a day or two, then it’s worth trying to identify the cause and taking remedial action.

What can I do if I get a lot of low readings?

Your monitoring diary will help you identify what you were doing – in terms of activity, eating, drinking, or taking medication – before your low readings. Once you have figured out the reason for the low readings you can decide what action to take to prevent them from recurring. If you are unsure what steps you should take, talking to your health professional might help you determine a course of action.

Can low readings do any harm?

If you have repeated low readings, you are less safe while driving and they may reduce your awareness of when you are starting to have a hypoglycemic attack. This lack of awareness is dangerous because if you are not able to react to the early warning signs you will be less able to treat yourself. Taking action quickly in response to low readings, such as having a glucose drink, will help keep or restore your warning symptoms. Avoiding hypoglycemic episodes altogether for a few weeks can also help.

Is it okay to round my test results up or down to make whole numbers in my diary?

Yes. The range of your results is more important than the exact tenth of a milligram that the decimal point indicates. If you have a reading of 133.4 you can round down to 133, while if you have a reading of 133.5 or more then you could round up the next whole number, in this example 134.

Why are carbohydrates important in Type 2 diabetes?

Carbohydrates, also known as sugar, starch, and fiber, are broken down into glucose when they are digested, and insulin then helps that glucose move into your cells to be used for energy or stored for use later on. If you have Type 2 diabetes, your body is resistant to insulin so the glucose continues to circulate in your blood. You need carbohydrate-rich foods for energy, but choosing carbohydrate foods that your body digests at a slower rate will help reduce the demand on your insulin and thereby keep your blood glucose level more stable.

Which carbohydrates are digested quickly?

Any form of sugar, which can be called dextrose, glucose, sucrose, fructose, maltose, or lactose, is digested easily and rapidly. This is why sugar causes your blood glucose level to rise sharply, resulting in an immediate demand for insulin. Eating sugar in small quantities, and/or with or after other food, slows down its absorption so that it doesn’t have a dramatic effect on your blood glucose.

How do starch and fiber affect my blood glucose?

Starch and fiber include bread, potatoes, rice, pasta, cereals, and legumes and beans. They are broken down into glucose relatively slowly during digestion. Unlike simple carbohydrates, they do not raise your blood glucose sharply, so eating them helps keep your blood glucose level balanced.